title: Exercise guidelines for inpatients following ventricular assist device placement: a systematic review of the literature.
abstract: BACKGROUND
  For patients with end-stage heart failure awaiting transplantation, lack of donor organs has created an increased need for alternatives such as left ventricular assist device (LVAD) implantation. The purpose of this study is to determine safe and effective exercise parameters for physical therapy in the acute care setting.
  
  
  METHODS
  A systematic literature review was conducted according to PRISMA guidelines using Sackett's Levels of Evidence to rate the evidence. Multiple databases were searched with inclusion criteria of: available in English, inpatient care up to 6 months postoperatively, description of intervention type and exercise parameters.
  
  
  METHODS
  no defined exercise parameters, outpatient treatment, infection post VAD, or palliative or hospice care post VAD.
  
  
  RESULTS
  Six studies out of 1,291 articles met inclusion criteria. Common exercise parameters used were the Borg Rating of Perceived Exertion scale 11-13 (6-20 scale) or > 4 (0-10 scale), Dyspnea scale > 2 (0-4 scale) and > 5 (0-10 scale), mean arterial pressure (MAP) 70-95 mmHg, and LVAD flow > 3L/min. Levels of evidence ranged from case controlled to expert opinion.
  
  
  CONCLUSIONS
  Current evidence on inpatient exercise parameters for patient's status post LVAD implantation is not sufficient to suggest definitive guidelines; however, these exercise parameters provide a reference for patient care.
authors.affiliation: Walsh University, North Canton, OH.
authors.forename: Rachel
authors.initials: R
authors.lastname: Scheiderer
authors.forename: Courtney
authors.initials: C
authors.lastname: Belden
authors.forename: Darla
authors.initials: D
authors.lastname: Schwab
authors.forename: Casey
authors.initials: C
authors.lastname: Haney
authors.forename: Jaime
authors.initials: J
authors.lastname: Paz
keywords: exercise; physical therapy; ventricular assist device